With the current state of the pandemic in the United States, COVID-19 will be part of our world for the foreseeable future. We anticipate that employers will continue to be faced with the need to develop mitigation strategies as COVID-19 eventually enters a more endemic phase.
Our new normal requires that business decision makers have well-considered systems in place to keep their employees, students and customers safe in places of business and on campus. To that end, Verily’s team of clinicians, epidemiologists, and researchers have assembled considerations and best practices for navigating the current environment.
When preparing your testing and vaccine plan, it’s important to understand your population’s risk level. How vulnerable are the people at work? Are most people already vaccinated? Our research shows that with the right safety precautions, a regular testing program, and high levels of vaccination, most employers can bring their employees safely back to work.
Customizing return to work for your population
Most employers and schools have implemented some form of return to work guidelines, whether those be social-distancing and masking policies, online symptom or vaccine tracking, or COVID-19 testing programs. That’s why at Verily we made our Healthy at Work product modular–so that those who have gaps can fill them with specific components. For example, some clients have Verily carry out their COVID-19 PCR testing because we offer a wide range of flexible options, spanning from on-site testing (managing that first return to work week, for example) to mail home test kits. In addition, those who wish to incorporate antigen testing into their program can have their employees self-report antigen test results directly into our system. Others just need the vaccine tracking feature. Regardless of who provides the features, every school or employer needs to be sure they have carefully considered the three main components:
- Manage Outbreaks: Understand what’s happening in your sites and communities in terms of COVID-19 outbreaks
- Maintain Site Safety: Testing and other surveillance programs such as symptom tracking help to ensure strong onsite safety
- Population Risk: Understand population-level vulnerabilities to COVID-19 among your workforce or student body in order to properly manage and mitigate high risk pockets
Should I use antigen or PCR for my testing strategy?
The two main forms of viral testing are antigen testing and polymerase chain reaction (PCR) testing. Antigen tests are also commonly referred to as “rapid tests” because they can return results in 15-30 minutes and can be used at the point-of-care. That said, antigen tests for SARS-CoV-2 are less sensitive than PCR tests. PCR tests usually take longer to generate results because laboratory processing time is required, but can detect SARS-CoV-2 earlier in the disease’s progression due to the higher sensitivity.
Because antigen tests are relatively inexpensive and can offer quick results, some schools and employers are interested in incorporating them into their COVID-19 workplace mitigation strategy. We anticipate that antigen testing may be useful as a complement to PCR testing. For example, as antigen testing is most accurate when individuals have a high viral load (the amount of virus found in the body), it may be helpful in confirming COVID-19 when individuals are showing symptoms. It is less accurate than PCR tests, however, for ongoing asymptomatic and pre-symptomatic surveillance testing. It is estimated that more than 25% of cases may be transmitted by asymptomatic individuals, so it is important to identify these individuals and reduce the risk of infection.
Manage the impact of false positives
One drawback of antigen testing is that it is vulnerable to user error. The CDC also notes, “Despite the high specificity of antigen tests, false positive results will occur, especially when used in communities where the prevalence of infection is low.”
False positives are high-cost to employers. Once an employee tests positive, they may need to self-isolate and receive a negative COVID-19 test prior to returning to normal work activities (see CDC for latest official guidance). Even if an employee subsequently tests negative for COVID-19, quarantine cannot end before day seven following daily symptom monitoring. As a result of these false positives, the costs of rapid antigen tests may end up being higher to employers than a thoughtful PCR-based program.
Still, the convenience of rapid, at-home antigen tests can offer complementary benefits to a regular PCR-based testing program, which is why Verily’s Healthy at Work program also offers the ability for employees to upload antigen test results to our system.
Enhance safety while managing cost
An option that leverages best-in-class testing methods while controlling for cost is pooled PCR testing. Pooling refers to the process of combining multiple samples into a single test. This results in conservation of reagents, which is typically the most costly and resource-intensive aspect of PCR testing. When the expected rate of positive detection is low, the pooling method requires ¼ to ½ the number of tests as standard PCR tests. Verily's investigations have determined that pooling is an effective model for testing that can efficiently scale with increasing demand without compromising performance. Verily is able to offer pooled testing that can provide the dual benefit of PCR testing sensitivity at a cost comparable to antigen testing. Verily’s COVID-19 RT-PCR Test can detect SARS-CoV-2 in samples containing the Omicron variant. Read more about pooled testing.
Verily has deep expertise in scaling PCR testing and developing innovative approaches that improve efficiency. The Verily CLIA-licensed, CAP-certified Clinical Lab — which was established in 2020 in response to the surging demand for COVID-19 testing and lab capacity — has processed over 800,000 test samples as part of Healthy at Work. The lab has played a critical role in Verily’s COVID-19 response initiatives and contributed to the body of research surrounding COVID-19 testing techniques, which Verily has made publicly available. Verily continues to focus on advancing COVID-19 research and diagnostics while processing thousands of samples per day for Healthy at Work customers.
Vaccine management and test tracking
Implementing new policies and systems for vaccine management will be a critical part of establishing and maintaining a safe, COVID-19-free environment. Through Healthy at Work, administrators like benefits leaders or workforce managers can view and update the vaccination status of their Healthy at Work participants. Participants will receive organization-specific instructions for providing proof of vaccination through the Healthy at Work digital interface.
Healthy at Work administrators can log into the Admin Console and add confirmation of the vaccination based on the proof submitted by each participant in the manner specified.
Once logged in the system, vaccination status will be added to a participant’s profile. Participants may then receive a digital vaccination pass and/or clearance to return to work or school, depending on the organization’s policies. Administrators also have access to a real-time dashboard showing eligibility status for all employees, including vaccination and testing adherence, while enabling communication with employees not in compliance.
Conclusion
Nearly two million tests have been administered across Fortune 500 companies and leading universities through Verily Healthy at Work.
“The health and safety of our team is our top priority as we continue to navigate the global pandemic and gradually resume our driving operations. That's why we’ve partnered with Verily, an Alphabet company focused on healthcare and life sciences, to provide integrated COVID-19 testing, symptom and exposure screening, and data analytics for our front-line team members and partners.” - Waymo
“Atlanta University Center Consortium schools are committed to a thoughtful, data-centered and science-based approach to mitigating the spread of COVID-19 on our contiguous campuses. This moment requires deliberate and innovative problem solving through the engagement of thought leaders and researchers in higher education, working with companies like Verily and leveraging the tremendous expertise of Morehouse School of Medicine to help set a high standard in the way we promote health and safety of AUC students, faculty and staff collectively and the nation as a whole.” - George T. French, Jr., chair of the Atlanta University Center Consortium Council of Presidents and president of Clark Atlanta University
EUA and Disclaimers
Verily COVID-19 RT-PCR Test EUA Summary
Verily COVID-19 RT-PCR Test Patient Fact Sheet
Verily COVID-19 RT-PCR Test Healthcare Provider Fact Sheet
Verily COVID-19 Nasal Swab Kit Instructions for Use